I went to see my doctor
He said I’ve got some bad news
You’re gonna be singing them
No fuckin’ fuckin’ cancer blues.

A couple of weeks back my doctor informed me that my PSA level was high. I had never heard of PSA levels, but was about to get an education. PSA stands for Prostate Specific Antigens, and a high PSA level can be caused by many things, one of which is cancer. My doctor ordered a second blood test. The result was an even higher PSA level. So my doctor ordered a biopsy. That isn’t something I’d do for kicks on a Saturday night, but not too painful. The doctor and ultrasound technician were wonderfully professional about it.

Last week I got the results of the biopsy. Cancer. High risk cancer.

IMA GONNA DIE!!!

Well, okay, calm down. Prostate cancer is one of the most treatable forms of cancer. I have friends who went through treatment years ago and are doing fine now. Most people with prostate cancer will die of something else.

I asked the urologist what would happen if I do nothing. He said I will die, but they can’t say when. Maybe in a year. Maybe in five. And the death gets painful when the cancer goes into the bones or lymph nodes. Treatment is obviously a good idea.

Treatment? Well, first they are going to shut down my libido completely. Reduce my testosterone level to zero. So that’s it for sex. Whimper.

Then they will send me for radiation treatment – five days a week for seven weeks, in a city two and a half hours away by car. The treatment only takes fifteen minutes. Travel time would be five or six hours a day. Or I could stay at the cancer lodge at forty bucks a night. Or I can move into my sister’s condo in another city and be closer to treatment but away from the homestead.

Before the treatment starts, they want more tests – a bone scan and an MRI – to see whether the cancer is confined to my prostate. I’m not sure what it means if it isn’t. Maybe I’m toast.

Last week the medical imaging department at the hospital injected me with radioactive isotopes. After a brief delay to let them circulate, they scanned me from head to toe. I’ll get the results in a couple of days.

Through all this I remain oddly calm. I’m symptom free. And happy. I’m either living in the moment, or I’m in heavy denial. Every once in a while the reality that my sex life is coming to an end hits me. Hard. I have always loved sex. I’ve never been able to figure out whether I’ve been any good at it, but if appreciation has any value for my partners there should have been some shared pleasure involved. At least I can’t recall any complaints – aside from one former lover who told me she didn’t like the way I kiss. That was hard to take. But I’ve also been told that I’m a lesbian in a man’s body, which I took to be the crowning compliment of my sexual career.

I suppose this is the way Olympic level athletes feel when they realize they are too old to compete. It’s still possible to enjoy the sport as a bystander and coach. But damn, I’m going to miss it.

“Eye in the Sky” is a close look at modern warfare, fought remotely with drones, hightech cameras that look like birds or beetles, and real time connectivity to the drone operators in Las Vegas, face recognition technicians in Hawaii, political decision makers in Britain, America, and China, and intelligence agents risking their lives on the ground in territory held by a hostile militia.

The plot: There are a couple of terrorists that a British colonel has been tracking for years. They are bad bad people, responsible for many death. One is a British citizen and the original mission, overseen by political advisors and lawyers, is to capture her and take her back to Britain for trial. But capture turns out to be impossible. They’ve been tracked down to a safe house and it’s a perfect time to eliminate them with a missile strike. But there’s a problem. Changing from a capture plan to an assassination requires political approval.

So the movie is really about who will make the decision. Politicians dither and insist on deferring to higher authorities. After the series of buck passing, approval is given. A missile strike is authorized. But then… a young girl is selling bread just outside the house, and there’s a very good chance she will be killed too. Collateral damage. Is that acceptable? This launches a whole new round of buck passing. The military feel it is a necessity, and killing the girl would be unfortunate but worth it because of the lives that will be saved if the terrorists are killed.

Then the remote camera sees two young men being fitted with suicide vests. They are preparing to find a crowded location where they can kill as many innocent people as possible. If they leave the house there will be no way to stop them.

That does it. Approval is finally given. But the young airman who must pull the trigger rebells and demands a new collateral damage assessment. We bounce around the globe to ever higher levels of government while the British Colonel tries to get a decision out of the bureaucrats and policy wonks. Legal advice is sought. Rules of engagement are cited. An agent on the ground, in a very risky spot controlling the remote camera, tries to buy the girl’s bread and send her home. He is recognized and barely escapes with his life.

Spoiler alert: It is a very good movie, and I hope you will see it. So don’t read further unless you have seen the movie, don’t intend to see it, or don’t care. I’m giving it all away.

Finally, after many delays and objections, much discussion, much buck passing, and a second attempt to get the girl out of the way, the approval is given. The missile is launched.

The terrorists are killed, mission accomplished, but the girl is terribly injured. Her mother and father flag down a militia patrol jeep. The soldiers set their machine gun aside to carry the family to the hospital. Doctors and nurses rush to help. Will the girl live? Sadly, no. She dies. The mother and father collapse in grief over her body. It’s been gripping. It’s been good.

And then, after all the great drama, the solid performances, the tension, the plot turns that work, after all this great stuff the movie fails. It’s in the denouement, after the resolution. The audience is treated to a number of scenes in which each character in turn expresses shock and remorse, variously guilt and anger, recriminations and rationalizations. “Don’t EVER tell a soldier that he doesn’t know the cost of war.” And finally we jump the shark into bathos with a flashback of the dead girl playing in her yard. The message: War is hell and innocent children die and we all feel terrible about it.

And that’s a bullshit message.

So, how should the movie have ended? There could have been a teenaged boy who is part of the girls extended family, just a background character, maybe her older brother. Brief scenes show that he’s a moderate, loves his baby sister, wants the girl to be educated, doesn’t like the fanatics who are terrorizing everybody, wants more freedom and fewer restrictions. After the girl is killed we see this boy being fitted with a suicide vest. He’s been radicalized.

Instead of a soppy emotional ending, we see that the effort to fight terrorism has created a new terrorist. Because this is what is happening. An American military expert said it: We are creating terrorists faster than we can kill them.

That’s how the movie could have ended. It could have said something really important about the war on terror. Such a pity. It came so close.

When a beloved entertainer or closer to home friend dies, I’m seeing RIP on all the Facebook posts and I simply can’t write that. We need an alternative.

RIP stands for Rest in Peace. But this person is not resting. This person isn’t doing anything. Their body has been reduced to ashes, or filled with formaldehyde and left to pollute some cemetery or crypt. They are just gone. Suggesting that they should rest in peace seems downright silly.

My partner says she thinks of this as “all their pain and suffering is over now so they have no worries” and this is fine, except they don’t exist any more. So they have no worries, but no anything else either. They don’t exist anymore. Reminds me of one of my favourite Phil Ochs songs.

Pretty much sums it all up. When we’re dead we’re just gone. Solid gone.

So what is an alternative to RIP. I’m thinking of something like HBM (He’ll Be Missed) or SBM (She’ll Be Missed) or the gender neutral TBM (They’ll Be Missed) or maybe IFS (I Feel Sad) or GBNF (Gone But Not Forgotten) I don’t know. Any of these work better for me than RIP.

I’ve been politely rejected, with encouragement to try again in June. And that’s okay.

I applied to write for Free Thought Blogs, along with many other aspiring bloggers apparently. It would be a thrill and an honour to be associated with that group. ‘Twould make me so proud to stand with the likes of PZ and Greta and Digital Cuttlefish. But aside from being reduced to a whimpering pile of humble by the very thought of joining them, I’m not sure I would recommend me. One of the things FtB is struggling to achieve is more diversity. Do they need another privileged cis white male voice? I think not.

No matter how witty and insightful my perspective on life might be, or how clever my use of language, my opinion about just about anything isn’t worth a pinch of guano in the grand scheme of things.

As a radical atheist feminist mangina SJW, I really belong on Free Thought Blogs. Except I don’t need to be there, and they don’t need me. I’m perfectly happy with the readership I have. I’m not sure I’d be happier with a wider readership, and I can certainly do without the hate mail that all the FtB people seem to attract. My hate male is… non-existent. Aside from one pathetic old man who wrote in all caps and now seems to have gone away, or perhaps died, I’ve never had any hate mail.

Closest I’ve come to hate mail is being called a hypocrite for declaring that this blog promotes tolerance, while being intolerant of religion. That’s pretty weak tea compared to what the women endure.

Still, I hope that FtB likes my writing enough to offer me a spot when they open up the roll again in June. If they do, I’ll have to decide whether that’s actually a good idea.

Some years ago I was on a tour in China, sitting beside a Mormon woman from America. She told me the horrifying story of a young good looking Mormon boy who confessed to a series of murders of young women. He told the authorities that he had been lead to this by his addiction to pornography, she said.

I expressed some surprise, and explained that Denmark, a country that had legalized pornography had seen a drop in the number of sex crimes in all categories.* Perhaps it’s possible that one Mormon boy could become a serial killer because of pornography, but it certainly looks more like an exception than the rule.

So that was years ago. Very recently I read an article entitled “Ted Bundy’s Success is a Feminist Issue”. I’ve never paid much attention to serial killers, and didn’t know a lot about Bundy. So the article prompted a Google search that brought up the Wikipedia entry in which I find these paragraphs:

On the afternoon before he was executed Bundy granted an interview to James Dobson, a psychologist and founder of the Christian evangelical organization Focus on the Family.[317] He used the opportunity to make new statements about violence in the media and the pornographic “roots” of his crimes. “It happened in stages, gradually,” he said. “My experience with … pornography that deals on a violent level with sexuality, is once you become addicted to it … I would keep looking for more potent, more explicit, more graphic kinds of material. Until you reach a point where the pornography only goes so far … where you begin to wonder if maybe actually doing it would give that which is beyond just reading it or looking at it.”[318] Violence in the media, he said, “particularly sexualized violence,” sent boys “down the road to being Ted Bundys.”[319] The FBI, he suggested, should stake out adult movie houses and follow patrons as they leave.[6] “You are going to kill me,” he said, “and that will protect society from me. But out there are many, many more people who are addicted to pornography, and you are doing nothing about that.”[319]

Multiple biographers,[320][321][322] researchers,[323] and other observers[324] have concluded that Bundy’s sudden condemnation of pornography was one last manipulative attempt to shift blame by catering to Dobson’s agenda as a longtime anti-pornography advocate, telling him precisely what he wanted to hear.[325] While he asserted in the Dobson interview that detective magazines and other reading material had “corrupted” him and “fueled [his] fantasies … to the point of becoming a serial killer”, in a 1977 letter to Ann Rule he wrote, “Who in the world reads these publications? … I have never purchased such a magazine, and [on only] two or three occasions have I ever picked one up.”[326] He told Michaud and Aynsworth in 1980, and Hagmaier the night before he spoke to Dobson, that pornography played a negligible role in his development as a serial killer.[327] “The problem wasn’t pornography,” wrote Dekle. “The problem was Bundy.”[328]

################################# end quote from Wikipedia ############################

So this is the source of my Mormon bus rider’s information. A questionable source indeed. Bundy was not raised a Mormon, and it’s stretch to characterized him as a clean cut Mormon boy. It seems he was just telling an anti-porn crusader what he wanted to hear.

Reading about Bundy was the intellectual equivalent of swimming in sewage with my mouth open. I’m left with the thought that the evil that was Ted Bundy continues after his death, spreading misinformation to the gullible anti-sex crusaders and contributing to repressive sexual attitudes. Fucker. Although I don’t support the death penalty, I’m sure glad he’s dead.

I spent yesterday afternoon at a jam packed memorial service, held in a very large Catholic church, for a teen who died in a skiing accident.

Surrounded as I was by such obvious pain and grief, it was not the time to sound off on my own beliefs or show disrespect for the apparently sincere expressions of utter nonsense. Not the right time to mock. It was disconcerting to hear so much crazy, and so many people who seem unable to understand that time passes and things actually change.

If I were to lose an arm, yet run around insisting that my arm was still there, that I would be reunited with my arm soon, that my arm still existed, healthy and invisible, in another place, people would think me insane. If I were to lose my job, yet insist that the job was still mine and that soon the pay cheques would come my way again, people would recognize that I was in denial. Yet somehow the massive denial that goes with the death of a loved one is an accepted, encouraged, and expected (demanded?) characteristic of human beings.

There was a lot of crazy in my afternoon yesterday. I just hope I never catch it.

We need a good evo-psych theory to explain this. (So that PZ Myers can rightfully scoff at it as a “Just So Story” ) I love head hair. Long, shiny, or clipped very short, it doesn’t matter. It’s all sensual. Beautiful. Body hair in moderation is also okay, sort of, and what Alan Ginsberg called “fuzzy fucky blondes” are a major turn on. But nose hair? Repulsive. Why? It’s just hair, and has as much functionality as any other hair we sport, serving as a first line of defence against dangerous dust and asbestos particles. Yet it turns the stomach.

Hair that we are not accustomed to can have the same effect. I well remember my first German class at university. It was lead by a jolly overweight woman who didn’t shave her armpits. I had a very visceral reaction to those clumps of black hair. Leg hair on a woman gets the same reaction from most men, but I’m convinced that this is just a cultural thing, like finding a circumcised (read mutilated) penis more attractive than an intact one. I no longer react to armpit hair or body hair on a woman. Somehow I seem to have accepted that it as natural, and I prefer natural. But nose hair is different.

Sir Tim Hunt doesn’t care about his nose hairs.

Does anybody find nose hair attractive? Is there a group of nose hair fetishists out there someplace? Probably, but they are being very quiet about it.

I remember my grandfather showing up at our home when I was a child. He was nearly blind, and could be forgiven for wearing nose hair walrus tusks that looked to me to be two inches long. My father took him to our bathroom and trimmed him to a respectable state. No doubt the day will come when I also lose control of my nasal foliage, but right now I’m embarrassed if so much as a single hair shows itself outside of my nostril, which they all seem to want to do.

In “The Black Knight” there’s a scene in which Martin Lawrence plucks his nose hairs and dances around in pain after each pluck. It’s supposed to be funny. I used to cut my nose hairs. Now I pluck them on the, apparently unsubstantiated, theory that they will be slower to grow back. The pain is not that bad.

In the first episode of “Six Feet Under” there’s a scene where the ghost of the father, played by Richard Jenkins, is watching his own funeral from a lawn chair at the edge of the cemetery. The sunlight is sparkling on a nose hair that must extend at least an inch under his his nose. Either the director and cameraman felt this added to the realism of their show, or they missed it. My bet is, they missed it. My bet is there was gnashing of teeth in the screening room that night.

Some months ago I attended an Imagine No Religion conference in Richmond, B.C., Canada, where, amid a stellar list of speakers that included Amanda Marcotte,Richard Dawkins, and Lawrence Krauss, one of the speakers was Doctor Harriet Hall. Dr. Hall spoke about the dangers of religious beliefs interfering with health issues, a very interesting but horrifying talk during which we learned about parents trying to cure their child’s cancer with prayer. From the audience I asked if she had evaluated the evidence put forward by advocates of circumcision, fully expecting her to scoff at the shoddy methodology and obvious flaws in the research. What a shock and surprise. It turned out that Dr. Hall is not against infant male circumcision. She considers it trivial, with some possible heath benefits.

In a subsequent email exchange, I set out to change her mind. Not a lot. I just wanted to change her position from “It’s up to the parents.” to “It should be up to the owner of the penis.” Apparently I failed. But the discussion was very interesting. Here it is in full:

Dear Dr. Hall

I very much enjoyed your talk at Imagine No Religion 5 this morning, if one can be said to enjoy receiving such information. Perhaps “appreciated” is a better word.

I was, however, as I’m sure you gathered, quite shocked by your stated position regarding infant male circumcision, as were the other men at my table and several others I talked to.

You told me about a patient of yours who requested circumcision, not knowing that he had already been circumcised. Well, believe me I know I was circumcised. I am missing the frenulum, the ridge band, and of course the foreskin. From what I have read, admittedly by anti-circumcision campaigners, these are actually the most sensitive parts of the penis, with far more nerve endings and sensitivity than the glans. Given that the main aim of circumcision historically was to reduce sexual pleasure and “cure” masturbation, I find it hard to believe that my sexual function was not affected.

I just reviewed your post on the subject, and see that you have already dismissed the arguments I might make regarding the various studies and scientific evaluations. So it almost seems that there is no point in pestering you further on this subject.

Never the less, I feel compelled to ask you to change your mind. As a man who was a victim of this mutilation (and I feel fully justified in using both these words) I feel it is my duty to stop this practice from being done to others. Having an authority of your stature condoning the procedure is unacceptable.

Some of the facts you quote are simply wrong, and I’m sure you will realize that they are wrong if you give them a bit more critical thought. For example, you state that 10% of uncircumcised infants will require circumcision later in life. I just spent nine years living in China, where circumcision is very rare. If this were true, there would be long lineups outside doctors offices of men requiring circumcision. I asked a Chinese doctor about this and he laughed at the very idea. He told me that they treat infections with drugs and that any other problem with the foreskin can be solved very simply with stretching or very limited surgery.

I suspect that this figure of 10% comes about because doctors in the past have assumed that the foreskin is a like the appendix, just a trouble maker, and the first answer they suggest if there is any problem at all, no matter how minor, is circumcision. My uncle Bill was circumcised at the age of twelve to cure a bed wetting problem.

The ignorance of doctors about the foreskin and how it should be treated is absolutely shocking. For example, my first born son was of course not circumcised. Not having a foreskin myself, I assumed that the foreskin should be pulled back before the child urinated. This is incorrect. The foreskin is normally adhered to the glans until puberty. But when I could not retract my son’s foreskin, I called our doctor who paid us the courtesy of a house call and retracted the foreskin by force. This is the wrong thing to do. It is painful and dangerous, as well as unnecessary. I’m just lucky that no damage was done.

I can’t think of any diplomatic way to suggest that you might also be ignorant on this subject, but I hope you will admit that this is a possibility. You may have seen this already, but if not please watch this video. And please forgive me if it gives you no new information, but it accurately describes my experience of intercourse and the problems I am having as I grow older.https://www.youtube.com/watch?v=BgoTRMKrJo4

It is of course possible for people of good will to receive the same information and come to different conclusions. But please consider revising your position that this is a decision that should be left up to parents. There is only one person who should make this decision, and that is the owner of the penis.

Yours sincerely

DH

Dear Mr. Harmless,

“I was, however, as I’m sure you gathered, quite shocked by your stated position regarding infant male circumcision, as were the other men at my table and several others I talked to.”

Others in the audience were not only not shocked, but came up afterwards to tell me they agreed with me. One woman told me her son had had to be circumcised as a teenager for a medical reason and he complained loudly to her that he wished she’d had him circumcised as an infant so he wouldn’t have even remembered the procedure and would not have had to go through the suffering he did. Here is the position of the American Urological Association https://www.auanet.org/about/policy-statements/circumcision.cfmThey are the experts and they have access to all the published evidence and have considered all the anti-circumcision arguments.

“I find it hard to believe that my sexual function was not affected.”

I find it hard to believe that it was. You have no way of knowing for certain. Most men who are circumcised later in life report no diminution of sexual pleasure or function. I understand that you feel you have been deprived, but in my entire lifetime experience I have only run across two men who regretted being circumcised as infants. Most men think it is no big deal and are happy that it was done if only because it makes hygiene simpler.

“there is no point in pestering you further on this subject.Never the less, I feel compelled to ask you to change your mind”

This is somewhat disrespectful, since it assumes that I didn’t research the subject adequately and didn’t consider all aspects before I formed an opinion. I am not going to ask you to change your mind, but I will ask you to recognize that your opinion is based on emotional and ethical factors and personal experience and on one-sided information from anti-circucision activists rather than on a fair and dispassionate evaluation of the medical risk/benefit facts alone.

You dispute the 10% figure, but you have not presented any real evidence to make me question it. Instead of providing a reference that quantifies the rarity of circumcision in China, all you have told me is that one doctor laughed at the idea. You accepted hearsay and you didn’t ask a Chinese urologist. I imagine you could find doctors here that laugh at the idea because they haven’t personally seen cases, but I’m sure you would find that the vast majority of urologists wouldn’t laugh at all. The 10% figure may not be accurate, but I assure you there are solid medical indications for performing circumcisions after the neonatal period, and there is no solid evidence that drugs or stretching are effective alternatives to surgery. And even if they were equally effective, they might result in less patient satisfaction overall. Without scientific studies, we have no way of knowing.

“My uncle Bill was circumcised at the age of twelve to cure a bed wetting problem.”

The YouTube video you cite is by a woman who is not a physician or a scientist but a nurse and an anti-circumcision activist; she is clearly biased, and she offers only speculation based on reasoning from basic science, not supporting evidence from clinically relevant controlled studies. There are studies like this http://arstechnica.com/science/2007/08/study-shows-circumcision-results-in-no-loss-of-sexual-sensation/ that make me question her opinions. Anyway, videos are not an acceptable source of scientific information; I rely on the primary sources in the published literature and on expert consensus.

To make my position clear: my assessment of the evidence is that there is a small health benefit to circumcision that outweighs the slight risk. The medical benefit is not large enough for doctors to recommend the procedure, but it is sufficient to justify doing the procedure when informed parents request it. The ethical issue is separate from the medical issue. I have ethical reservations about performing any elective procedure on a child too young to give informed consent, but that would include even things like ear piercing in baby girls which was standard practice in Spain when I lived there. There is a spectrum: ear piercing is trivial, so I can’t get too upset about it; and I can’t get too upset about circumcising males, but I do get very upset about female genital mutilation.

There is a difference between pain and suffering. Infants experience pain, but they don’t experience the kind of suffering from pain that adults do because they don’t have the psychological component. I used to do circumcisions without anesthesia, which was the standard practice at the time (1970s). We did assembly line procedures where we would strap several infants down to a restraining board. They would cry because they were restrained, but by the time the last one was strapped down and we got back to the first one to start the procedure, often they would have fallen asleep. Even the ones that continued to fuss did not fuss any more during the actual cutting, which was rendered painless by the way the procedure was done. Newborns cry bitterly for various reasons: when hungry, when wet, when blood is drawn, and sometimes even when their clothes are changed. I seriously question the studies that purport to show long-term effects, because if circumcision had those effects I would expect to see the same effects from every infant who had a heel-stick to get a blood sample for PKU testing, or from any infant who required hospital treatment for an illness or who had IV’s inserted, often after multiple attempts in various body parts including the sensitive scalp.

I retired in 1989, and the last circumcision I was called on to do was in 1983. I have reconsidered somewhat. If I were asked to do one today, I would sit down with the parents and make sure they fully understood the issues. If they gave truly informed consent and were set on having it done, I wouldn’t refuse to do it because they would just find another doctor to do it, and I was confident that I was very skilled and likely to do a better job than most doctors would.

I respect your opinion and I am not trying to change your mind. I am only hoping that you will respect my opinion and not think it is uninformed or that I arrived at it lightly.

Harriet Hall, MD

Dear Dr. Hall:

First of all, let me say how much I appreciate getting such a thoughtful and comprehensive response from you. It was unexpected, and I’m sure most people in your position would have simply ignored my letter, if they read it at all.

With all respect, and with apologies for the implied disrespect of my previous letter, I still think you are wrong about a number of your points. But I’m not asking you to change your mind either. I do understand and respect your position. It echoes the position of many of my family member who consider me a bit of a kook for even being concerned about this subject.

I’m sure you know the theory of cognitive dissonance, which states that a person is most likely to reject evidence against a belief when they are heavily invested in that belief. This is one reason a religious person will cling to a belief in the power of faith, even after causing the death of their child, which surely is a very heavy investment indeed. I’m impressed by the investment, and resulting cognitive dissonance, around this practice. We are asking parents to recognize that they have done damage to their children, asking doctors to recognize that they have done harm to patients, and asking “victims” to recognize that their sexual function may have been compromised. No wonder this is an uphill battle to change social attitudes.

Still, social attitudes do change, if not exactly with the speed I would prefer. When I was a child, infant male circumcision was unquestioned and often automatic. Now at least it is considered a valid question. I anticipate the day when somebody requesting the circumcision of their child will be greeted with looks of horror and disgust.

Waris Dirie, author of “Desert Flower” and one of the earliest campaigners against FGM, nevertheless supported the circumcision of her son and justified it with the same rational used by her culture to justify FGM, i.e. hygiene and aesthetics. She praised the “proud and clean” appearance of her son’s penis. Such irony. To those of us who do not believe that the foreskin was one of God’s mistakes, a circumcised penis evokes the same reaction that one might have to a vagina with excised labia. You may feel this is irrational. Perhaps it is. But for someone who has swung over to my side of the issue, it’s an undeniable feeling and not one that can be argued away.

I have been asked to give a talk at a summer service of the local Unitarian church. Although I am heartily sick of this subject, and feel that I have paid and continue to pay a price for voicing my opinion on it, you have inspired me to make infant male circumcision the subject of my talk. You are quite correct in stating that almost all circumcised adults have no concerns about what was done to them. But it is also true that they do not know the anatomy of the foreskin and associated structures. I regret that I will be the one to educate some of them. Just as campaigning against infant male circumcision can have no benefit for me, since it won’t change the past, there seems to be little value in generating resentment and anger in adult men. But while the rate of circumcision in Canada has dropped from 50% in 1998 to about 20% in the year 2000, this means that there are still a lot of infants treated to a questionable intervention. If there is justification for the procedure, I think it’s worth debating.

Thank you again for your considered and thoughtful response to my letter. And let me add that the work you do in educating people about the dangers of faith based medical decisions and pseudoscience is incredibly important. Despite our disagreement on this one subject, I’m sure we have many more opinions in common.

I hope you will consider me a new friend and supporter.

Warmest Regards

DH

Just remember, nothing you can say about the anatomy of the foreskin and associated structures constitutes proof that there is statistically significant harm from circumcision or that it makes a clinically significant difference. It’s entirely possible, and you may be convinced that it is very probable, but it has not been established to the satisfaction of rigorous science. I will stay tuned to see if better evidence emerges.

Peace. Live long and prosper.

Harriet

Dear Dr. Hall:

Thank you again for taking the time to give me your thoughts.

As a result of our discussion I have determined to try to stop speaking with such certainty on this issue.

Embedded in one of the links you sent me was a link to a very balanced article by Jessica Wapner which included the following:

“How can experts who have undergone similar training evaluate the same studies and come to opposing conclusions? I’ve spent months scrutinizing the medical literature in an attempt to decide which side is right. The task turned out to be nearly impossible. That’s partly because there is so much confused thinking around the risks and benefits of circumcision, even among trained practitioners. But it’s also because, after reading enough studies, I realized that the debate doesn’t have a scientific conclusion. It is impossible to get to the bottom of this issue because there is no bottom.”

You have helped me to realize that there is little point in arguing the science. Our largest sexual organ is our brain. I have certainly enjoyed sex, and I confess to making an art form of masturbation. So I am reconsidering my decision to speak on the topic at the Unitarian Fellowship. What is the point of getting a group of, mostly quite elderly, men to feel about their penises the way I feel about mine?

I would like to correct one misapprehension I left with you. The Chinese doctor I spoke to was in fact a practising urologist. He is as resident at a hospital in Wuxi where my wife and I were asked to help the staff with their English. I also mischaracterized his response as “laughing at the idea”. He is not the kind of person to laugh. But he did tell me that he has seen few problems with foreskins in his practice, and that any problems he did encounter were solved simply, without circumcision.

Also, I mentioned my uncle not as a statistical argument but simply to illustrate that circumcision has been done for strange and trivial reasons in the recent past. I believe it is often still done today when better, less permanent and drastic, alternatives are available.

I’m impressed by the fact that the thoughtful and balanced article by Jessica Wapner did not include her own conclusions, which were described as “lengthy” and left off because she is not herself a medical authority. They did include a link to her original article and, what a surprise, her rather brief conclusion is the same one I have reached. It seems to me that evaluation of the merits of circumcision has been left in the hands of medical authorities for far too long, given the history of their conclusions. I mean no disrespect to your profession, but really: Masturbation does not cause insanity, epilepsy, poor vision, or curvature of the spine, all of which have been claimed by medical professionals in the past. Circumcision does not cure masturbation nor does it protect me from diseases I am at no risk of ever catching. There are big questions about whether it will help stem the epidemic of HIV in Africa, given that a man who has repeated exposure is not protected at all. Perhaps it is time we listened to intelligent people who have examined the subject without a vested interest or the cognitive dissonance I mentioned in my last letter.

When I brought up this issue at the Imagine conference, I fully expected to hear from you that you had looked at the various studies supporting infant male circumcision and concluded that they have all the validity of studies supporting the efficacy of prayer. Proof once again that one should not ask questions unless prepared to accept the answer. But you have given me a much more nuanced view of this issue, and for this I sincerely thank you.

Again, thank you for taking the time to write. Your thoughts have been very valuable to me.

Warmest regards

DH

I had been thinking about your concerns about the pain neonates experience with circumcision and its long-lasting effects, and I e-mailed a pediatric expert to ask him about it. I wanted to share with you what he said:

“The issue of pain in neonate is a good one. A lot is problematic because it’s animal data. What we know in humans is that neonates who experience an acute bout of significant pain have increased response to vaccine shots but it normalizes after a few months. Neonates who have chronic pain, such as when micropremies ride vents for weeks or have numerous procedures, have blunted pain response to shots later but again it normalizes by a year I think. I’ll have to review the literature.

I did about 300 circs while at TCH and probably less than ten didn’t sleep through it. Heelsticks are routine with screening and jaundice testing and absolutely cause pain and crying too. There is no evidence I’m aware of to suggest that properly done uncomplicated circumcision causes meaningful issues regarding pain perception down the road. There is even evidence showing that babies post-circ likely feel no meaningful discomfort after the lidocaine wears off.”

Perhaps knowing that most babies sleep through the procedure will make you reconsider what you have heard from the anti-circumcision activists. Perhaps not. Anyway, I wanted to share.

Harriet

Dear Harriet:

Thank you for sharing this.

I recognize that many of the claims made by opponents of circumcision, grasping for any argument they think might support their position, may be wishful thinking. And I do not think that a modicum of pain is really a problem anyway, if it’s in a good cause. It’s almost beside the point. My son had to endure quite a few extremely painful IV sessions as a child, but this in no way prevented me from delivering him to the hospital emergency department.

I also recognize that my objections to circumcision may have more to do with my sense of having been violated than with any actual harm done, though I found your certainty that sexual function is not affected difficult to understand. When a protective covering is removed, resulting in thickening and keretinization of the formerly protected skin, I find it hard to believe that sensitivity is not affected. (There I go with the argument from personal incredulity again.) That without even considering the possible value of the nerves and cells in the ridged band and frenulum. Perhaps one of the reasons i feel this way is because, though I have fathered three children, I have always had a hard time achieving ejaculation and wearing a condom reduces sensations to the point where I might as well have a wooden penis. As I age this problem is becoming much worse. But sexuality is so dependent on the brain that I can’t be certain this has any connection to my circumcision. Perhaps i just need to find the right therapist.

As the article you linked to stated so well, there can be no scientific answer to this issue. There are too many competing studies and conflicting claims to ever sort it out. We all have a problem deciding what to believe, and what to reject. I could match your statement from the American Academy of Pediatrics with any number of statements from other medical associations. B.C. Medical (our healthcare plan here) says it isn’t necessary and refuses to pay for it.

For me it comes down to some simple principles: Is it medically necessary? (Even proponents only claim slight and speculative benefits. It’s a stretch to claim that it’s necessary, given that so many men do just fine without it.) If it is considered necessary, can it be delayed until the individual can give informed consent? (Yes, it will be more painful later in life. But certainly not nearly as painful as my recent total knee replacement. An adult can chose to put up with some pain if they believe in the value of the operation.) Is there a potential harm? (This question is not settled, but I think you will admit that there is potential harm involved, that it is possible that those who believe sexual function is compromised are correct. And if causing anger and resentment constitutes harm, I’m a case in point.)

I think the question any doctor should ask is this: Is infant male circumcision ethical? Does it violate the injunction to do no harm?

If a doctor concludes that it is not ethical, then it is not a decision that should be left to the parents or to anybody other than the owner of the penis. And it is not an operation that should be performed by an ethical doctor, even if, as you said “because they would just find another doctor to do it, and I was confident that I was very skilled and likely to do a better job than most doctors would.”

Again, thank you for sharing. Please note, I have conceded the point that pain caused to the infant is not relevant to the discussion.

Warmest regards

DH

How refreshing to have someone concede a point. That happens so rarely! Of course, as you say, it is a very minor point.

You say you find it hard to believe that sensitivity is not affected. How do you reconcile that with adults who get circumcised and report that it makes no difference in their sexual satisfaction?

As for circumcision being “medically necessary,” no-one is saying that. All we say is that there is a small medical benefit that outweighs the medical harms, but that is too small in magnitude for doctors to recommend the procedure. I share your concerns about the ethical considerations, but not enough to regret having done circumcisions. Although in retrospect I probably should have had longer discussions with parents for better informed consent before doing the procedure. “Do no harm” doesn’t mean avoiding anything that might cause harm, it means not doing things that are likely to cause more harm than good. Appendectomies cause harm: they violate body integrity, cause pain, and leave a scar. But they save lives and clearly are ethical because the good they do outweighs the harm.

I have truly enjoyed our discussion: it’s a pleasure to exchange ideas with a true critical thinker instead of a true believer.

Best wishes,

Harriet

Dear Harriet:

I too have greatly enjoyed our conversation. I seldom get the chance to discuss this with anybody who has the depth of knowledge and experience that you have, so conversations tend to become very polarized and rife with unsupported opinions, wild speculation, and assumptions taken as gospel.

This last question you asked gave me pause: “You say you find it hard to believe that sensitivity is not affected. How do you reconcile that with adults who get circumcised and report that it makes no difference in their sexual satisfaction?”

This actually gives me little difficulty. Sexual pleasure and satisfaction is a very complex and subjective experience. It is influenced to a great extent by expectations and attitudes. In my own case, it took me some time to learn to let go and experience an orgasm, which involves the whole body and is very different from a simple ejaculation. I have met men who have never experienced an orgasm and claim to get as much pleasure from sex as they might get from a hearty sneeze. Guilt and repression figure prominently into sexual responses.

I have never met or talked to a man who was circumcised as an adult. In China I was told by the late middle aged wife of a late middle aged man that her husband “had to be circumcised” late in life because of a problem of some kind. But I never had the opportunity to talk to the man himself. They are Mormons, obviously very sexually repressed, and this same woman told me about a young Mormon man who had killed several women and, when confessing, blamed his actions on an addiction to pornography. She absolutely believed that this was the cause of his murderous rampage. I’m more inclined to believe it was the teachings of his religion. In any event, I would not trust the testimony of her husband when he gives an assessment of his sexual satisfaction.

The only other adult I know of who was circumcised as an adult is the husband of a very dear Chinese friend of mine. I was called in as a counsellor when they had a crisis in their marriage, caused by his work forcing him to entertain clients with prostitutes and his confession that he had used their services. In response to a hysterical phone call from my young friend, I took a “black taxi” from Wuxi to Shanghai, a trip of several hours, specifically to spend time with both of them and help them calm down. It was a breach of trust that almost destroyed their marriage, and a terrible thing to observe.

That was close to the time when we left China. Since then I have learned, through emails from the wife, that her husband had himself circumcised in the hopes that it would help her get pregnant. Go figure, eh. We are hoping to have a trip back to China next year. If that happens, I hope to have an opportunity to ask him about his sexual satisfaction. It won’t surprise me if he reports no difference. The reason, again, is the cognitive dissonance I keep harping on. He has made a huge investment in his decision to be circumcised. For him to realize that it has had negative results will require accepting evidence he will not want to accept.

Finally, my reason for not being persuaded by men who were circumcised as adults and report no difference in their sexual enjoyment is that they are not the only voices. There are legions of men who report the opposite. Of course these reports are coming from the anti-circumcision contingent, and are subject to the same influences that affect the opposing opinion. So again, there is no way to have confidence in their assessment and no way to finally resolve the question. Sigh.

I have not read the original studies cited in these links. I’m sure it would do little to settle the issue for me.

My own opinion simply relies on what seems to me to be common sense. The skin of the glans of the penis is supposed to be a thin mucous membrane, similar to the skin on the inside of the cheek. After circumcision it hardens, thickens, and resembles a dried up lake bed. To claim that this makes no difference to sensations is difficult to accept.

I also buy the argument that we have different types of cells and nerve endings, and that different parts of the body are more sensitive than other parts. As a teenager, I chopped the end off my right thumb while splitting kindling. Our family doctor took skin from the inside of my forearm and transplanted it to the end of my thumb to cover the wound. That skin is still there. It has a very different sensitivity to touch than my other thumb has. I have since read that if the doctor had simply dressed the wound, but kept it open, the skin of my thumb would have grown over to cover it. Apparently a very young child will actually regenerate a finger, providing the wound is not closed with stitches. But of course surgeons want to do what they were trained to do, which is to perform surgery. Our family doctor was an excellent surgeon. The transplant from my forearm took. I’m only left with the question of whether it needed to be done in the first place, and I don’t think it did. I have been tempted to have that transplanted skin removed and give my thumb a few months to repair itself, just to see what the truth might be. But though it bothers me, it doesn’t bother me enough to want to subject myself to that inconvenience in the interests of knowledge.

Anyway, I digress. Tests of sensitivity of the penis were initially done with the assumption that the foreskin was nothing special. Just skin. I don’t know for sure, but I suspect that much of the testing and evaluation was done by doctors who had been circumcised as infants., and much of the testing was done on circumcised men. More recent testing of intact men seems to indicate a huge number of nerve endings and receptors in the foreskin, the frenulum, and primarily the ridge band. It seems unlikely to me that removal of this healthy tissue could be an improvement, and far more likely that it degrades the sexual experience, which, after all, was the original goal of the operation as expressed so eloquently by Maimonedes, the Jewish mystic (http://www.cirp.org/library/cultural/maimonides/ This link is amusing, but again it is from an anti-circumcision site so not to be completely trusted.) and championed by more “modern” authorities like Dr. Harvey Kellogg, who believed that all sexual activity should be discouraged except when required for procreation and that circumcision should be done as painfully as possible so that the boy will forever associate pain with his genitals and refrain from “bodily self pollution”.

Oh dear, Harriet. It seems you got me on my hobby horse again and I have spent my morning writing this letter instead of digging out our basement, which is our huge project these days. In closing, let me say that I do not want you to regret having performed circumcisions. Regret is pointless. I do hope for a tiny change in your position, away from saying that it is a decision that should be left to parents and the cultural forces of tradition and religion. I hope you will see that this is a decision that should rest rest with only one person, the owner of the penis.

Warmest regards and all the best

DH

Several months went by with no further correspondence, but I grew increasingly curious about whether my words had any affect at all. So I had to ask. Sadly, the answer was disappointing.

Dear Harriet:

I hope this finds you well and happy.

Some time has passed since our extended conversation about infant male circumcision. Every now and then I think about the things we discussed, and I can say that your point of view has caused me to temper my opinion. I wonder whether my expressed point of view had any impact at all on you. The only person who can answer this question, of course, is you.

My final point in our discussion was this one: “I do hope for a tiny change in your position, away from saying that it is a decision that should be left to parents and the cultural forces of tradition and religion. I hope you will see that this is a decision that should rest rest with only one person, the owner of the penis.”

If you could give me your thoughts on this, I would really appreciate it.

And now I have another request: I would like your permission to post our discussion on my blog. If you would like, I will remove your name and any reference that might identify you. But my preference would be to leave your name and a brief biography on your words, because you express a legitimate position and speak with authority and experience.

Engaging with me as fully as you did was a kindness I didn’t expect and very much appreciate. I hope you will agree to let me share our discussion with the world.

Warmest regards

Darwin Harmless

Dear Darwin ,

I agree that as a general principle any elective surgery should require the patient’s permission. But in practice I bow to cultural and ideological realities, and I see infant circumcision as too trivial to object to, especially since as a doctor who has evaluated the evidence I agree with the American Academy of Pediatrics that there is a small health benefit that exceeds the risks. I see this as a spectrum. Ear piercing in infant girls has no health benefits and a small risk, but I don’t object to it. I don’t object to infant circumcision for informed parents who feel the benefits are worth the risks. Parents who refuse to vaccinate concern me far more than those who choose circumcision. I DO object strongly to female circumcision for obvious reasons: risk, no health benefit, and serious consequences for quality of life.

I have not seen any convincing evidence that circumcision impairs sexual pleasure or performance. I think you would have been much better off if you had never read any of the anti-circumcision propaganda. I think that has done you much more harm than the surgery.

You have my permission to post our discussion and name me.

Harriet

Harriet:

Thank you for the quick response.

I appreciate your position, though I profoundly disagree with it.

Warmest regards

DH

But then, of course, I couldn’t leave it at that. I had to fire off one final email, pointing out my rejection of advice that amounts to “live in blissful ignorance.”

Harriet:

Please believe that I am smiling while I type this but: “I think you would have been much better off if you had never read any of the anti-circumcision propaganda. I think that has done you much more harm than the surgery.” is an interesting statement.

Are you suggesting that ignorance is better than knowledge, and that exploration of reality is a bad thing if it causes discomfort?

If so, then again we disagree. I have had moments of anger and regret during this investigation, but I would much rather know what was done to me and explore the issue than remain in childish ignorance that it had ever been done. You must admit that the early justifications for circumcision – religious convictions, anti-sexual attitudes, paranoia about masturbation – approach and pass the point of absurdity. To not know about this history would be a shame.

We had a dog once that had only three legs. It got along fine, and could run and keep up with the other dogs. I suppose if all the other dogs had also been missing a leg, then that situation would be perfectly normal and it would be cruel to explain to them that the legs were missing because of a mixture of superstition and medical ignorance.

For me, I prefer to know why things are the way they are. Even when that knowledge causes a little distress. It holds the hope that things can be different in the future, as indeed they seem to be. The world seems to be slowly swinging around to my point of view, given that fewer and fewer circumcisions of infants are happening now.

Cheers

Darwin Hamless

P.S. i recently acquired a new friend, an intact man. We have discussed this issue. He is as happy about having a foreskin as I am unhappy about not having one. Damn. Unhappy is not the right word. I am a very happy person. I can accept reality. This is not an issue for me at all, personally. It’s an exploration of social customs and a very interesting study of how attitudes form and change. Please believe that I don’t spend my time moping around wishing I had a foreskin. But on the other hand, I refuse to accept that this violation of my person was trivial, and that I should shut up about it while it continues to be done to other infant boys.

You mentioned Female Genital Mutilation, and put it in a completely different category. I fail to see the difference. Sunat, as practised in Indonesia, is the ritual nicking of the clitoral hood. It is far less destructive than infant male circumcision, yet it is banned in America. And not just because nobody has thought up a medical justification for it, but because it is from another culture that we don’t accept as valid. Sunat is the trivial end of FGM, which ranges all the way from that symbolic gesture to excising the labia, equivalent to infant male circumcision, and excising the labia and clitoris, equivalent to cutting the glans off the penis. But it is all the same thing. It is genital mutilation to varying degrees, with justification based on tradition, religion, and, yes, medical opinion that it is cleaner and more hygienic.

And there I go again, off on the hobby horse. What I will say about everything you have written is: You may be right.

But then again… you may be wrong. 🙂

Addendum: I thought I had published this months ago, but apparently it was caught up in my drafts folder. So here it is.

In the months since this was written, I have often thought of Dr. Hall. In general, I like her. But I also see her as a great example cognitive dissonance in action. She accepts the anecdotal evidence from some – those circumcised late in life who say that it had no affect on their sexual enjoyment – while rejecting the testimony of those who said that it had a profound affect on their sexual enjoyment. She falls back on the authority of one medical group, while totally dismissing the authority of many other equally qualified groups. It seems that evidence presented by those against circumcision is not to be trusted, while those who see it as acceptable, and possibly beneficial, are to be trusted. While she sees those opposed to circumcision as “true believers”, she fails to see that she herself is also a true believer.

Where I find her arrogance particularly galling is in the assumption that my feelings are not valid, and have only been generated by information from the intactivist lobby. I have been angry about being circumcised since I first learned about it, at the age of seven, long before I knew that anybody else in the world thought it a barbaric and harmful practice. Invalidating my perceptions and feelings is not an effective argument for her opinion. In this she is profoundly wrong.

I just visited your site, and having a blog on my own (http://artikelvijfentwintig.blogspot.com – but it’s in Dutch) I wonder if you would join me in something I wish all bloggers of free speech would participate.

In about 2 months, 7th January 2016, it will be the sad anniversary of the killings of Charlie Hebdo. I think this day should be remembered for eternity, and remembered by publishing a Mohamed cartoon. I intend to do so on my blog, and I announced it already.

Would you join me in this endeavour, by publishing on your blog that day a Mohamed-cartoon, and by writing to other bloggers that you know to participate in this Charlie Hebdo-day ?

Thanks in advance for your reply

Art. 25

Art.25 is the article of the Belgian Constitution that guarantees the freedom of the press and the abolishment of censorship.

##############################################################

The original Draw Mohamed Day was back in 2010. It’s worth taking a look at the history of that protest. But I do like this idea, and if I can remember to do it I shall post my own drawing of Mohamed on January 7th. Perhaps you’d like to join me.

Welcome. Welcome to Canada and congratulations on becoming a Canadian citizen. You are joining a great country, as the debate you triggered by deciding to wear the niqab at your citizenship ceremony proves.

As I’m sure you know, many in Canada would like to follow the lead of France and the Netherlands and ban the wearing of the niqab. I am not one of those Canadians. I believe that you have every right in a free country to wear whatever you want, even if what you are wearing is considered rude and offensive to millions of your fellow citizens. I believe in the right to offend. You have not come to a country where people riot or murder over perceived insults.

Zunera Ishaq, or possibly somebody else. Who can say?

Unfortunately you have come from a country where such things do happen. I’m sure you are aware of Salman Taseer, the Pakistani politician who was murdered by his own bodyguard because he called for the abolition of the death penalty for insulting Islam, and defended a woman who was facing death under that horrible and unjust law. When the murderer appeared in court, supporters showered him with rose petals. Salman Taseer’s son, Shabaz, who was a witness at the trial, was also kidnapped and murdered. So this is a part, possibly just a small part but a part none the less, of the culture you have left behind. I think you can understand why Canadians would not want to see that culture in your new country.

So that explains our first reaction to your traditional garment. For us it represents a horrible, brutal, disgusting, odious, malignant and oppressive culture. The aura of that culture clings to the niqab like a bad smell. For us it is far more offensive than any cartoon or verbal statement could ever be. When you wear it, I hope you will be aware that we find it offensive and why.

Our offence taken goes beyond an acute distaste for the culture the burka and the niqab represent to us. Many of us have been accused of racism when we criticize the wearing of these cultural symbols. But race is something that a person does not choose and can do nothing about. I am a man of Caucasian descent. These are things I did not choose and can’t change. But the customs and trappings of my culture are things I can choose and can change. There are many actual racists in Canada, and many racists, in fact all racists, are indeed ignorant. But this is not a matter of race but of culture.
My offence is not founded on ignorance but on verifiable news reports from your original country.

So I reject the ad hominem that is thrown at people who object to your display of freedom. We are not necessarily racist, though some may be. And there is a second and a third source of our offence. I’ve read that one purpose of your complete covering is to prevent men looking at a woman and thinking impure thoughts, that they cannot control their uncontrollable lust. This seems to me unlikely to be true. Even if it is true in some cases, it is an insulting assumption about me and most men. It infantalizes us as a gender. It is also ineffective, in that men assume there is a woman under that cloth and their imagination is quite able to give an image to what the garment conceals.

Canada is a country of inclusion. We welcome you. By wearing the niqab or the burka, you say to us that you do not want to be included. You want to stay in your own culture, insulated from the common culture of by far the majority of Canadians. A large part of our communication is through body language and facial expressions. You deny us this access to your thoughts and feelings. You say, to our understanding, that while you claim to have come here because you like Canada and like our culture of freedom, in fact you don’t. You would really prefer to be back in the culture you have left behind. It should hardly come as a surprise when many Canadians suggest you would be happier if you went back where you came from.

It is not my place to tell any woman what to wear. If being, at the very least, provocative, if not rude and offensive, is your aim, then you have succeeded. If none of this was your intention, then please understand that it is the result no matter what your intention might be.

I support, even applaud, your offensive statement. But please understand that you are being offensive. Please do not be surprised when people respond by being and acting offended.